Two PREDICTIONS that came true! - An update for physicians on the business of medicine.

In the past month Dr. Lakowsky and the rest of the team here at Reimbursement Rx has published some pretty bold statements.  Well based on recent developments, it looks like those statements were right!


Remember our rant about MACRA and how poorly thought out we claimed it is?   We stated how "they haven't thought about it" because we believe that the authorities proposing the incentive structure within MACRA didn't really think about all its problems - most obvious of which was how to reward physicians when all of them comply with the new regulations.

Well, just as we expected, those authorities are changing their minds!

An article in the April Issue of the New England Journal of Medicine reported that authorities are now questioning and rethinking those proposed "quality" measures because they don't make sense!

"With a level of bipartisan support that has become rare, Congress passed the Medicare Access and CHIP Reauthorization Act (MACRA) in 2015, eliminating the SGR. The purpose of the legislation was to move Medicare toward reimbursement based more on outcomes and value. The Medicare Payment Advisory Commission (MedPAC) has now questioned whether the current version of MACRA accomplishes these goals or even moves the system in a better direction."

The article goes on to point out flaws in the physician compensation bonus structure that would result from implementing MACRA - exactly what we had pointed out! 

It's unclear right now how this situation will develop, but we are happy to report that it looks like the original proposed flawed system will NOT be enacted!  


In a recent article ("Direct Primary Care - What it's missing!") , we wrote about Direct Primary Care and how we believe that the DPC model only makes sense as a cost-saving measure for patients if insurance companies pay the retainer, and not the patient themselves. 

Well, the Centers for Medicare & Medicaid Services (CMS) has been looking into just that idea and has recently announced that it is looking to allow physicians to contract directly with the Medicare beneficiaries they serve! (Read more about it here.)

Dubbed Direct Provider Contracting, this new proposed model is exactly what we predicted would be proposed. While this concept is still being fleshed out, advocates for physicians have been generally supportive of this proposal

Again, you heard it here first! 

We are looking forward to seeing the results of the debate on Direct Provider Contracting, and are in support of such a model being enacted. Regardless of the outcome, we will report back with updates on this issue!

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